Picture: ISTOCK
Picture: ISTOCK

The Mpumalanga health department faces medical negligence claims of more than R7.6bn, more than 40% of which centre on children allegedly born with cerebral palsy, Parliament heard on Tuesday. This is more than half its budget allocation for the 2018-19 fiscal year, which stands at R13.3bn.

The figures cast the spotlight on the province’s weak public health service, which has seen its institutional maternal mortality ratio (iMMR) deteriorate over the past four years from 108 per 100,000 live births in 2014-15 to 120 in 2017-18. The iMMR is considered one of the key indicators of the strength of a health system, as women are particularly vulnerable during childbirth: in Italy it was four per 100,000 live births in 2015.

Parliament’s health portfolio committee has asked provincial health departments to report on the state of their hospital services. Last week, both Gauteng and Western Cape briefed MPs, emphasising the growing service pressures they faced. On Tuesday it was the turn of Mpumalanga and Eastern Cape.

Mpumalanga’s head of health Savera Mohangi said the province currently faced 158 medico-legal claims of R3.3bn relating to obstetrics and gynaecology cases. "A single claim can cost between R12m and R40m," she said. There were also a large number of claims relating to orthopedic cases, partly due to the province’s shortage of orthopedic specialists, she said.

She told MPs that while there had been some improvements in care, such as better immunisation coverage, the provincial health department nevertheless faced immense challenges. For example, a shortage of ambulances, an aging fleet and staff shortages had led to a deterioration of the department’s emergency response time over the past three years: only 71% of urban cases were responded to within 15 minutes in 2017-18 compared to 75.5% in 2015-16.

Over the same period, the proportion of rural cases responded to within 40 minutes fell to 68% from 71%.

There is only one ophthalmologist for the entire province, which is home to 4.4-million people. A spate of attacks on staff has forced it to post armed guards in all its hospitals.

The Mpumalanga health department is not alone in confronting potentially massive medico-legal bills. Eastern Cape faces medico-legal claims of R24.3bn, according to documents presented to the committee. The province has seen the scale and volume of medico-legal claims soar and has, to date, paid out R1.1bn and R433m in legal fees.

Both provinces are attempting to use mediation to resolve claims more efficiently. Mohangi said seven cases had been finalised since mediation was initiated in 2016-17, totaling almost R2bn.

The financial risk posed by the growing burden of medico-legal claims has prompted the government to proposes changes to the way it settles successful claims against it. The State Liability Amendment Bill, which was published for comment on May 25, proposes scrapping lump-sum settlements for medical-negligence claims of more than R1m and replacing them with a structured schedule of payments.

Successful claimants will be limited to receiving future healthcare services in the public sector at facilities that meet the standards set by the Office of Health Standards Compliance. If state services are not available, claimants will be able to use private healthcare services, but will be liable for the portion of their bills that exceed public-sector rates.

Former finance minister Malusi Gigaba said in October that the state’s pay-outs for medical negligence claims had grown at an average of 45% a year from 2012-13 to 2016-17.